Ovarian cancer - Diagnosing ovarian cancer

See your GP as soon as possible if you have any symptoms of ovarian cancer.

Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there's a history of ovarian or breast cancer in your family.

They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan.

If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

Blood test (CA125)

You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer.

However, CA125 isn't specific to ovarian cancer and it can be raised in conditions including endometriosis, fibroids, pelvic inflammatory disease and pregnancy, so a raised CA125 level doesn't definitely mean you have ovarian cancer.

The Lab Tests Online UK website has more information on the CA125 test.

The National Institute for Health and Care Excellence (NICE) has produced guidance that recommends testing for CA125 if you frequently experience: 

• bloating
• feeling full quickly and/or loss of appetite 
• pelvic or abdominal pain 
• needing to urinate urgently and/or frequently  

Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb).

If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation, you may also be tested for CA125.

If you're 50 or over and you've experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

Around half of all women with early stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you'll be referred for an ultrasound scan.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach.

The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present.

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and if it's spread. This is called staging.

Other tests you may have include:

• a chest X-ray
• a CT scan or MRI scan
• abdominal fluid aspiration – a thin needle is passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells 
• laparoscopy – a thin tube with a camera on the end is inserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy)

Staging helps your doctors to decide on the best kind of treatment for your condition. However, it's important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

The Cancer Research UK website has more information on further tests for ovarian cancer.

Stages and grades of ovarian cancer

Staging

If your test results indicate that you have ovarian cancer, it will be given a stage. The stage describes the size of the cancer and how far it has spread. The four commonly used stages of ovarian cancer are:

• stage 1 – where the cancer only affects one or both of the ovaries
• stage 2 – where the cancer has spread from the ovary and into the pelvis or womb
• stage 3 – where the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
• stage 4 – where the cancer has spread to other parts of the body, such as the liver, spleen or lungs 

This is a simplified guide. Each stage is further divided into categories A, B and C. Ask your doctor if you're not sure what stage you have.

Grading

The grade of cancer refers to the appearance of cells under a microscope. The grades are as follows:

• low grade – although abnormal, cells appear to be slow-growing
• moderate grade – cells look more abnormal than low-grade cells
• high grade – cells look very abnormal and are likely to be fast-growing

The Cancer Research UK website has more information on the stages and grading of ovarian cancer.